Volume 73 Number 3 May 2006	back to contents

1Department of Internal Medicine, 2Section of Pulmonary/Critical Care, and 3Division of Endocrinology, Morehouse School of Medicine, Atlanta, GA.

Address all correspondence to Xiaoqing Guo, M.D., Assistant Professor of Clinical Medicine, Department of Medicine, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310; e-mail: Guox@msm.edu

Accepted for publication June 2005.

Abstract

A 40-year-old black male with scleroderma lung disease presented with blurry vision and headache. His presenting hemoglobin was 22.3 g/dL and his serum erythropoietin level was surprisingly low. Although nocturnal hypoxemia was evident, his daytime resting arterial oxygen saturation was normal. The patient's symptoms of hyperviscosity improved after phlebotomy, as his hemoglobin gradually decreased to 18.3 g/dL. Repeat serum erythropoietin levels were in normal and high ranges. Patients with chronic interstitial lung disease and erythrocytosis could have normoxemia at rest and a normal or low serum erythropoietin level at the peak of erythrocytosis. A repeat sampling of serum erythropoietin and monitoring of oxygen saturation during sleep and exertion may help in diagnosis. Physicians should prescribe continuous oxygen therapy for patients with chronic interstitial lung disease and erythrocytosis, even if diurnal resting hypoxemia is absent.

Key Words

Nocardiosis, Scleroderma lung disease, erythrocytosis, erythropoietin, polycythemia vera.

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